Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | C1889 | MS |
NPI | 1003062480 |
---|---|
Provider Name | Mrs. Brenda Kay Crew |
First Address | Gulfport, MS 39503-3503 |
Second Address | Gulfport, MS 39503-3503 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2008 |
Last Update Date | 17/08/2008 |